I am eligible to return in good standing to any postsecondary institution I have attended

YesNo

If no, please explain

Planning Sheet

The following courses are the pre-nursing prerequisites required for a Bachelor of Science in Nursing degree at Charleston Southern University and must be completed or currently enrolled prior to applying.

All math and science prerequisites must be completed within 5 years at time of application.

Must have a GPA of 2.9 or better in all prerequisite courses with a “C” or higher.

For transfer students only - Official transcripts from all previous schools must be on file with the CSU Registrar by 5:00 p.m. on the Tuesday following Charleston Southern University’s finals week.

*Please print an unofficial transcript from MyCSU and submit to the College of Nursing advising office (if you are unable to print from MyCSU, contact your pre-nursing advisor)

Demographic Information

Please respond to each area. The College of Nursing responds to numerous surveys from professional, community and church organizations and the information you provide will assist us in providing accurate data to them. The information on this form is not used for admission decisions. See CSU Undergraduate Catalog for FERPA Notice of Directory Information Policy.

*Gender

MaleFemale

*Marital Status

SingleMarriedSeparated/Divorced

*Do you have an associate degree?

YesNo

If yes, specify major

*Do you have a baccalaureate or higher degree?

YesNo

If yes, specify degree and major

*Do you have plans or aspirations for further education following completion of a Bachelor
of Science in Nursing?

YesNo

If yes, what are your plans?

*Ethnic Background: (Check one)

American Indian/Alaskan NativeAsian or Pacific IslanderHispanic originBlack, not of Hispanic originWhite, not of Hispanic origin

If you are currently licensed as an LPN or CNA, please indicate your license number and the state in which you are licensed.

LPN or CNA

License Number

State

If accepted into the College of Nursing, students will be required to provide evidence of the following, prior to the first semester in the nursing program:

Level of health and ability necessary to perform essential functions of nursing care. Reasonable accommodations will be made for some disabilities. However, independent performance is expected in several areas including: observation skills, ability to communicate, ability to deliver physical care and perform technical procedures and ability to function in quickly changing environments and stressful situations. Health Forms will be forwarded for completion by a health care provider.

Completion of all required immunizations and titers (delineated on Health Form) including Hepatitis B

Completion of a TB test within 3 months prior to enrollment in nursing courses

Current CPR certification from the American Heart Association (BLS, Health Care Provider)

Personal Health insurance (Medishare programs do not qualify)

Professional liability insurance (information will be forwarded)

Criminal Background Check

Negative Drug Screen

I have read and understand the information on this form.

Fact sheets describing the documentation needed to be eligible for licensure as a registered nurse are available upon request in the College of Nursing. If there are questions as to the anticipated need to report a specific violation/conviction, disciplinary action, treatment for chemical dependency, or a psychiatric or mental health condition, students may call the South Carolina Board of Nursing at (803) 896-4550.

I certify that I have read the information contained in this application, understand the requirements and attest that all information provided by me is true and correct to the best of my knowledge. I understand that my falsification of an application is cause for disqualification or dismissal.